MEDICARE: DR. STEPHAN MICHAEL STERN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	23171	CA

General Provider Information

NPI Number	:	1366564718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHAN MICHAEL STERN DPT

Provider Business Mailing Address
First Line	:	357 CASTILIAN AVE
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-3608
Country	:	US
Telephone Number	:	805-657-0416
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 HODENCAMP RD
Second Line	:	SUITE 100
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5810
Country	:	US
Telephone Number	:	805-449-3429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	07/08/2007

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